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What is Incontinence?
Incontinence is the involuntary loss of bladder and/or bowel control, resulting
in the loss of urine and/or fecal matter, respectively.
-
Incontinence of the bladder, resulting in urine loss,
is often called "urinary incontinence" or "UI" for
short.
-
Incontinence of the bowel, resulting in loss of gas or
fecal matter, is often called "fecal incontinence" or "bowel
incontinence".
Who is affected by incontinence?
According to recent reports by the National Institutes of Health, in America
approximately twenty million adult women and six million adult men experience or
have experienced urinary incontinence - countless more are living with fecal
incontinence, and none of these statistics represent how many children are
affected by incontinence. One of the common myths about incontinence is
that it only affects older people or women. Actually, men, women and children of all ages
and races can experience incontinence, but it is more common in older adults and
women, especially women who have had children.
What factors can cause incontinence?
Incontinence is not a disease in and of itself. Rather, it is a symptom of
something else that is going wrong, or not working quite right, in the
body. That is why it's always important to see a doctor about any problems with
incontinence or leakage of urine or fecal matter. Click
here to see a list of factors that can contribute to incontinence.
What types of incontinence are
there?
There are a variety of different types of urinary incontinence, and
there is also fecal (also called bowel) incontinence. The two main types of
urinary incontinence are stress urinary incontinence (SUI), which occurs when
you laugh, sneeze, cough, or otherwise exert pressure on your pelvic floor, and
urge incontinence, which occurs when you
have a sudden and intense urge to urinate - even if you emptied your bladder a
short while ago. Click here to see a list of
the different types of incontinence.
What treatment options are available?
There are many different treatment options available
for both urinary and fecal incontinence, including Kegel exercises, electrical
stimulation, bulking agents,
dietary changes, medication, injections, and several types of surgeries. In some
cases, incontinence can't be treated, and therefore it must be managed using
tools such as absorbent products (including products often called "adult
diapers") and urine collection devices. It is important to speak
with a nurse or doctor before attempting any treatment, or if you use products
to manage incontinence. Click
here to see a list of the available treatment options for incontinence.
Contributing
Factors and Causes of Incontinence
Chronic Cough or Asthma
Diabetes
Hormonal Changes in Women
Medications
Neurological Conditions
Obesity
Pregnancy and Childbirth
Prostate Problems in Men
Smoking
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Contributing Factor or Cause: Chronic Cough or Asthma
Medical Reviewer: Diana
Hankey-Underwood, MS, WHNP-BC
Many people have urinary leakage when they cough, laugh or sneeze. This is
called stress urinary incontinence (SUI). During surgery, childbirth, or with
other physical stress, the muscles of the pelvic floor can become weak, and
don’t support the bladder and urethra (the tube leading urine out of the
body). This muscle weakness allows leaking during sneezing, coughing, picking up
something heavy, or other similar activities.
In
some cases, asthma or coughing all the time for many years can stretch the
muscles of the pelvic floor and may make tiny tears in the muscles. These tears
may cause stress urinary incontinence.
Prevention
In some cases, a chronic cough or asthma can't be prevented. However, in many
cases smoking triggers the chronic cough or asthma. Some people stop leaking
when they give up cigarettes. Pelvic floor exercises can help make the pelvic
floor muscles stronger.
Treatment
and Management
Many people who live with incontinence do not tell their doctors. In
most cases incontinence can be treated or improved. You may want to talk with
your health care provider about some of these options:
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Contributing Factors and Causes Listing
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Contributing Factor or Cause: Diabetes
Medical Reviewer: Catherine
DuBeau, M.D.
Type 2 diabetes can increase the risk and severity of both urinary and fecal
incontinence.
Why?
There are several factors that link diabetes and incontinence:
- Diabetes is often related to obesity, and obesity can cause incontinence due to the increased weight
placed on the muscles of the pelvic floor. Studies have shown that weight
loss may reduce incontinence.
- Diabetes can affect nerve
function, which can also affect the nerves in the bladder and bowel. Nerve
damage may lead to several changes in bladder function:
- The most common
occurrence is “bladder overactivity,” which can lead to urgency and
urge incontinence.
- Decreased bladder
sensation, leading to little to no warning before feeling the urge to
urinate, which can lead to episodes of incontinence.
- In persons with severe
and/or longstanding diabetes, the bladder muscle may become weak so that
you don't completely empty the bladder with each urination. Residual (or
leftover) urine in the bladder may lead to urinary tract infection. In
severe cases, the bladder does not contract, causing "overflow
incontinence.”
- When diabetes is not well
controlled and blood sugars run very high, your body tries to get rid of the
extra glucose by excreting it in the urine. This causes a large increase in the amount of urine
produced,
- Constipation, which affects nearly 60% of persons with diabetes,
can make it difficult to empty your bladder.
- Congestive heart failure
(CHF) from diabetes-related coronary
artery disease can cause your legs and feet to retain water, and can cause your
body to create too much urine at night. This can lead to getting up many times
at night to urinate, and can also lead to experiencing incontinence at night.
- Stroke from diabetes can affect bladder sensation and your ability
to hold back from urinating. Additionally, mental impairment can make it
difficult for the individual to toilet themselves (and when severely advanced,
even toileting with assistance becomes difficult).
- Mobility challenges due to diabetic neuropathy, peripheral
vascular disease, and amputation can prevent you from reaching a toilet,
removing clothing, etc. “in time”, leading to episodes of leakage. This is
called "functional
incontinence."
- Some medications for the treatment of diabetes, or for the
treatment of the complications of diabetes, can impair continence or complicate
its treatment:
Prevention
The best way to prevent incontinence associated with diabetes is to 1)
prevent diabetes and 2) work closely with your doctor to control blood sugar and
treat any associated hypertension, high cholesterol, and obesity. For those diagnosed with prediabetes, Diabetes Prevention Programs
focusing on diet and exercise can significantly reduce the occurrences of
urinary incontinence. Studies find that overweight women who lower their risk of
diabetes also lower their risk of incontinence.
Treatment
and Management
The
most important thing that persons with diabetes or prediabetes can do is tell
your health care provider if you experience frequent or urgent urination,
over-urinating at night, or incontinence. Studies
show that people experiencing incontinence often don’t tell their doctor. In
most cases, incontinence can be treated or at least managed comfortably.
Everyone's body is different, so everyone responds to treatment and management
techniques differently. You may want to discuss with your doctor trying some of
the following options:
Important Note
Incontinence in persons with diabetes is not always related to the
diabetes. The incontinence could be caused by completely separate factors.
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Contributing Factors and Causes Listing
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Contributing Factor or Cause: Hormonal Changes in Women
Medical Reviewer: Karen
Sasso, MSN, RN, APN, CCCN
Due to shifts in their hormonal balance, some women experience urinary
incontinence. Women may experience leakage of urine either with physical activity
such as coughing, sneezing, or lifting (called "stress urinary
incontinence" or "SUI"), or preceded by a strong and sudden urge (called
"urge
urinary incontinence") or both
("mixed
incontinence").
Why?
Women have the hormone "estrogen" in their body. Estrogen helps develop
female characteristics, and is also responsible for your monthly period by
causing the lining of your uterus to build up before being released every 28
days or so. Estrogen also helps your pelvic floor to be strong, supple and
stretchy, which gives you greater control over your bladder and bowel function.
Stress urinary incontinence is the most common type of incontinence experienced
as a result of a loss of tissue strength from declining estrogen levels in the
peri (before) and post (after) menopausal stage of life. Prior pelvic floor
injury from multiple or traumatic vaginal deliveries tends to contribute to a
higher incidence of stress urinary incontinence in menopause. Estrogen depletion
can contribute to more urgency, frequency of urination and sometimes urge
urinary incontinence.
As mentioned above, the
following can all cause changes to your estrogen levels, and thus cause
incontinence:
- Menopause: During
menopause your estrogen levels naturally decline, which can lead to
increased incontinence. Additionally, during the time leading up to
menopause, called “premenopause” or “perimenopause”, a woman’s
estrogen levels begin to gradually decline.
- Changes during your monthly
menstrual cycle: Estrogen levels change throughout your monthly cycle. Estrogen
is highest while ovulating. Right before, during, and right after your period is generally when
your estrogen levels are at their lowest, making you more likely to
experience leakage during that time in your cycle.
- Hormone Replacement Therapy:
There is conflicting evidence regarding whether or not hormone replacement
therapy can affect urinary incontinence, although some women claim to notice
a difference in bladder control when either starting or stopping HRT. In
some cases, women feel that the HRT helps them gain more bladder control,
and in other cases women feel that it causes further incontinence.
- Hysterectomy: A
hysterectomy can cause incontinence for a couple reasons: 1) Removing the
womb (uterus) changes the pelvic floor and can cause the muscles to weaken
and sag, which can cause incontinence; 2) Your ovaries are responsible
for creating most of the estrogen in your body. Sometimes the ovaries are
removed during a hysterectomy, which can lead to a significant drop in
estrogen levels.
Prevention
For most women, shifts in hormone levels are a part of life, whether from
the menstrual cycle during reproductive years or during menopause in later years
- these factors can't be changed. However, there are a few preventative steps
that women can discuss with their doctor:
- Pelvic floor
exercises:
Because the type of incontinence experienced due to hormonal changes is
usually stress urinary incontinence, strengthening the pelvic muscles can help to prevent
possible future problems with incontinence. Also, for women who experience
urge urinary incontinence, strengthening these muscles and contracting them
when you feel an urge to urinate can make the urgency subside and give you
enough time to get to the toilet.
- Hysterectomy options: If you
are in need of a hysterectomy, discuss your options with your doctor. If
leaving your ovaries intact is an option, you may find that it lessens your
risk of incontinence because even though the uterus is removed, the ovaries
will function independently from this.
Treatment and Management
Although changes in hormones may increase your chances for
incontinence, incontinence should never be accepted as a normal part of
life. A doctor who is interested in incontinence, and knowledgeable about
diagnosing and treating it, can help you find a treatment or management
technique. Some potential options to discuss with your doctor include:
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Contributing Factor or Cause: Medications
Medical Reviewer: Catherine
DuBeau, M.D.
Although some medications are designed to help with incontinence, others
(taken for a variety of reasons) can actually contribute to incontinence.
Why?
Medications affect many areas of our body - not just the area they are
intended to help. This is what we call "side effects".
Some ways in which medication side effects can cause or worsen
incontinence include:
- causing the body to produce
additional urine, making it more difficult to control the increased amount
- weakening the bladder’s ability
to empty
- causing swelling of the feet
- affecting how well the sphincter
(the muscle that closes the urethra and keeps urine in the bladder) closes
- causing constipation
- causing confusion
Prevention, Treatment and Management
You may not want to avoid a medication just
because incontinence is a possible side effect, but with your doctor's help you
might be able to reduce the symptoms by using a different type of medication, or
adjusting the dosage or timing. Never stop taking a prescription medication
before speaking with your doctor.
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Contributing
Factor or Cause: Neurological
Conditions
Medical Reviewer: Christine
Norton, PhD, MA, RN
Conditions affecting the nerves of the body, such as spina bifida, multiple
sclerosis, diabetes, and spinal cord injury, can cause a neurogenic bladder. In
some cases, incontinence may be one of the first signs or symptoms of a
neurological condition.
Why?
The body senses bladder fullness, and then empties the bladder, based on
messages the brain receives from nerves. When there is nerve damage, or a
condition blocking the messages sent or received by the nerves, the messages
between the brain and the bladder may not be sent and received correctly.
Conditions affecting the nerves can cause the brain not to receive the message
when the bladder is full, or could block the message sent by the brain: to hold
urine, or when it is appropriate to relax the sphincter muscle and empty the
bladder.
Treatment
and Management Techniques
Some treatment and management techniques that you might discuss with
your health care professional include:
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Contributing Factors and Causes Listing
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Contributing Factor or Cause: Obesity
Medical Reviewer: Diana
Hankey-Underwood, MS, WHNP-BC
People who are overweight are at a higher risk of experiencing stress urinary
incontinence.
Why?
The extra weight around the abdomen adds stress and pressure to the
muscles of the pelvic floor. Every breath, every cough, every giggle may tear a
few threads in the muscle. With time, this adds up. For more information, read
about stress urinary incontinence. Obesity
can also cause type two diabetes. This can cause damage to the nerves that
control the muscles of the bladder.
Prevention
The best way to prevent incontinence that is triggered or aggravated by
obesity is to maintain a healthy body mass index (BMI). There are many online
calculators that can help you determine your current BMI, as well as explain
your target or ideal BMI.
Doing pelvic floor
exercises, sometimes called Kegel
exercises, while pregnant may help women prevent incontinence, even when they
are older or heavier. Doing the exercises at all ages seems to help.
Treatment and Management
Many people who are overweight and lose weight
are cured of incontinence or have it much less often.
For more information on how to treat or manage your incontinence, please
see stress urinary incontinence. You may also want to read about
incontinence
and type two diabetes if you have been diagnosed with that condition.
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Contributing Factor or Cause: Pregnancy and Childbirth
Medical Reviewer: Beth
Shelly PT, DPT, BCIA-PMDB
It’s pretty common knowledge that pregnant women urinate more often due to the
extra weight on their bladder, but a surprising fact some people don’t know is
that many women experience urinary incontinence during pregnancy. Often that
incontinence will worsen after delivery. Usually symptoms will dissipate after
giving birth, but for some women the urinary incontinence continues.
Why?
There are several reasons why pregnancy and childbirth can cause
incontinence. While a vaginal delivery can cause incontinence (straining on the
pelvic floor during labor, complications due to episiotomies, and damage and
tearing due to forceps or a large baby), some studies also find that simply
carrying the weight of pregnancy can cause incontinence. There is also a
hormonal shift during pregnancy and during and after childbirth that may
contribute to incontinence.
Prevention
It is important for a pregnant woman to discuss the affects of pregnancy
and birthing on her pelvic floor with her health care provider. Your provider
can help you weigh the risks and benefits of different birthing choices, and
teach you exercises that may help prevent incontinence. Some possible
preventative measures to discuss with your provider include:
- Pelvic floor
exercises:
Several studies have looked at whether doing pelvic floor exercises during
pregnancy can reduce the chance and severity of incontinence both during and
after pregnancy. The studies have conflicting results (some say it helps,
some say it doesn't make a difference), but most experts agree that doing
pelvic floor exercises doesn't hurt anything, and since it may indeed help
to prevent incontinence, they are usually recommended.
- Avoiding routine episiotomies:
An episiotomy is a small cut made to the perineum to open up the vagina
and reduce the small spontaneous tears that can happen as the baby crowns.
Originally it was thought that one larger cut that can then be sewn closed
was better than the smaller tears. The National Institutes of Health now
recommends, for the sake of preventing incontinence, that routine episiotomies no longer be
performed.
- Choice of assisted vaginal
delivery: Sometimes when delivery is difficult, the health care provider may
turn to an instrument such as forceps or a vacuum extractor to assist with
the delivery. Before your birth, discuss the pros and cons of these
different devices should the need arise to use one during delivery.
Treatment
and Management
While consumed with caring for a newborn, taking the time to seek
treatment for incontinence may be the last thing a new mom wants to do, but it
is a very necessary and important step for several reasons. First, while the
pregnancy and/or labor and delivery probably contributed to the
incontinence, only a qualified health professional can tell you that for sure,
and it's important for your own health to rule out any other conditions that may
be the cause. Second, sometimes early intervention can make a difference with
incontinence - for example, treating pelvic organ prolapse before it gets worse. Third,
incontinence can easily start off as something "small and
insignificant" and gradually grow worse until you look back and realize
that it's affected your quality of life for quite some time. Some potential
treatment and management options to discuss with your health professional
include:
For More Info
The type of incontinence that is often associated with pregnancy
and childbirth is stress urinary incontinence. For more information, please read
about stress incontinence.
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Contributing
Factor or Cause: Prostate Problems in Men
Medical Reviewer: Nejd Alskiafi,
M.D.
Although statistically men experience incontinence less than women, about six
million men in America do experience urinary incontinence - about 17% of men
over the age of 60. In many cases, incontinence in men is caused by prostate
problems, or the methods used to treat prostate problems.
Why?
In some cases, men can experience the same types of incontinence as
women, and for the same reasons. However, one of the major contributing causes
to incontinence in men is prostate problems. According to the National
Institutes of Health, “The prostate is a male gland about the size and shape
of a walnut. It surrounds the urethra just below the bladder, where it adds
fluid to semen before ejaculation.” There are three major prostate problems
that can lead to incontinence:
- Prostatitis: Prostatitis, or
inflammation of the prostate, is the most common prostate problem in men
under the age of fifty.
- Benign Prostatic Hyperplasia (BPH):
As men age, their prostate gland grows. In some cases the enlargement can
become troublesome - a condition called benign prostatic hyperplasia (BPH).
BPH is a common problem, affecting more than 50% of men in their sixties. As
the prostate grows, it closes off the urethra (the tube leading the urine
out of the body from the bladder), and the bladder needs to contract harder
to get the urine out. After struggling to push urine out, the bladder can
become weakened and end up holding urine in, causing overflow incontinence.
BPH has many symptoms that vary from person to person, and it can be treated
in many different ways. Depending on the severity of symptoms, BPH can be
managed with lifestyle changes, medication, or surgery, and some of these
treatments, especially surgery, can lead to incidences of incontinence.
- Prostate Cancer Treatments: An
abnormal growth of cells in the prostate gland is prostate cancer.
Prostate cancer is the second most common cause of cancer-related deaths
among men, but when discovered and treated early-on, prostate cancer is
often very treatable. As with BPH, many of the treatment options for
prostate cancer can lead to varying degrees of incontinence, because the
prostate itself is very closely entwined with the sphincter (the small
muscle that clamps the urethra closed), so treatment of BPH and prostate
cancer can cause damage to the sphincter, which can result in stress urinary
incontinence.
Prevention
While the two main causes of incontinence in men - BPH and prostate
cancer - can't necessarily be prevented, early intervention can mean gentler
treatment and a reduced risk of incontinence. The signs of prostate problems
include difficulty urinating, a slow or "stop and go" stream while
urinating, a painful or burning sensation during urination, frequent urination,
and blood in your urine or semen. If you notice any of these symptoms, it's
important to see a doctor immediately.
The
recommendations vary as to how men should be screened for prostate cancer, but
generally men over the age of fifty are recommended to have an annual prostate
exam, including a digital rectal exam (DRE) and a blood test for the
prostate-specific antigen (PSA). African-American men and men with a history of
prostate problems in their family are recommended to begin these tests at the
age of forty or forty-five. Some doctors prefer to review the risks and
benefits, along with your specific risk factors, so that you can make a personal
and informed choice regarding the screenings.
Pelvic
floor exercises before and after prostate treatment can also potentially reduce
your risk of incontinence and help you retain bladder control.
Treatment
and Management Options
Incontinence is not uncommon for up to a year following prostate
treatment, however in most cases it will go away after a while. Waiting for it
to resolve itself can feel like a long and agonizing time, and in some cases the
incontinence will remain forever. While waiting to see if the incontinence will
dissipate it may be best to use absorbent products designed specifically for men
and/or urine collection devices (such as a condom catheter) or a penile clamp.
Men are often more uncomfortable than women with using these products, perhaps
because women are accustomed to buying and using similar products for their
menstrual cycle. Also, women generally carry purses and men often don't know how
to carry products when they are out in public. Many men remedy this by caring a
gym bag, briefcase, or backpack.
If
incontinence becomes a long-term challenge (more than a year post-treatment),
you may want to discuss the following options with your doctor:
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Contributing Factor or Cause: Smoking
Medical
Reviewer:
Tamara Dickinson,
RN, CURN, CCCN, BCIA-PMDB
Current and previous cigarette smokers are at a higher risk of experiencing
stress urinary incontinence.
Why?
Cigarette smoking causes chronic
coughing, which can damage the muscles
of the pelvic floor causing a loss of stability of the pelvic floor muscles.
Smoking is also known to be a bladder irritant.
Prevention
Not smoking is the best way to prevent incontinence associated with
smoking.
Treatment
and Management Options
While previous smokers are also at a higher risk of experiencing urinary
incontinence, quitting smoking now may reduce your future risk or severity.
Please read about stress urinary incontinence for more treatment and management
options.
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Types
of Incontinence
Enuresis
Fecal Incontinence
Functional
Incontinence
Mixed
Incontinence (combination of SUI and Urge)
Overflow Urinary Incontinence
Stress Urinary Incontinence (SUI)
Urge Incontinence or Overactive Bladder (OAB)
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Type of Incontinence: Enuresis
Medical
Reviewer: Julian Wan, M.D.
While most children eventually grow out of bedwetting (usually by the age of
five), five to seven million children in the U.S.
continue to wet the bed after the age of six. Many of these children eventually
stop wetting the bed in their late childhood or teen years, but some will
continue to experience enuresis as an adult. Rarely, adults who did not
previously experience enuresis will begin to experience bedwetting. This can be
a warning sign of worrisome health issues like diabetes, urine infection or
neurologic conditions. Nighttime bedwetting is called nocturnal enuresis, or
just enuresis.
Why?
The cause of enuresis is unknown, although there seems to be a strong
genetic link - often, one or both parents also experienced enuresis. There are
also other proposed theories:
- The human body produces a
hormone called vasopressin to hold onto water. Most people produce a surge
of vasopressin at night which causes urine to become more concentrated
(that's why urine is generally a darker yellow in the morning). Sometimes
people with enuresis don't produce the surge of vasopressin, resulting in
more urine than the bladder can keep in all night long.
- Many individuals with enuresis
are described as "very deep sleepers", so they don't awake when
the urge to urinate strikes. Some actually have sleep disorders such as
sleep apnea or sleep walking. If these problems exist, correcting them will
often improve or halt the enuresis.
- Some children will begin
wetting the bed as the result of new psychological stresses in their life.
This can be traumatic or benign events. A new school, new bedroom, or new
sibling are common examples.
- Incontinence of any kind can
be a symptom of an anatomic abnormality or other health concerns, so it's
always important to seek treatment from an interested and knowledgeable
health care professional.
- It is believed that some
children may simply have smaller bladders that are unable to hold the usual
amount of urine. Some children may grow out of bedwetting as they and their
bladders grow. This was a popular theory several decades ago, but recent
research suggests that this is not a major cause.
- It is not uncommon for
children with conditions such as ADD, ADHD, depression, and autism to also
experience enuresis, so there may be a link between these conditions and
bedwetting.
Prevention
Because most enuresis is thought to be influenced by genetics, at least
in part, prevention isn't possible. Efforts are often better placed in providing
a supportive and understanding environment for children as they learn to control
their bladder and bowel during both the day and the night. Keep in mind that
most children stop wetting the bed by the age of five, but bedwetting after the
age of five is not uncommon. When bedwetting does become a problem and medical
help is sought, it's important for parents to honestly answer questions about
their own medical history, including bedwetting - this will help the doctor
determine if the enuresis is caused by genetics, or possibly some other
condition.
Because
psychological stress can play a role in some cases, it may be helpful to seek
professional guidance during times of change in your child's life, including the
birth of a sibling, death of a pet or family member, or a move to a new home or
school. It's important not to punish a child for wetting the bed, and instead
accept that it is a medical condition over which they have little, if any,
control.
Treatment
and Management Options
There is no treatment option for enuresis that has a 100% cure rate,
which means you’ll probably have to experiment a bit with what works best for
your situation. The sooner you see a
doctor the sooner you can start figuring out what might be causing the enuresis
and what you can do about it. The following are some options to discuss with
your doctor:
- Some people find that helping
their child get more sleep helps them to have drier nights. Try an earlier
bedtime for a while and see if you notice a difference. (This may also work
with adults who experience enuresis.)
- Try avoiding fluids for about
two hours before bed. No one should ever go to bed thirsty, so drink some
water if necessary. Also be sure to avoid foods containing a lot of liquid
before bed, such as fruits, popsicles, etc.
- Avoid bladder
irritants,
especially before bed, such as citrus juices, chocolate, and especially
caffeine.
- Adults may want to use
absorbent products and children might try using pull-on type
diapers. Using absorbent products for older children is controversial: some
people claim that the use of "diapers" hurts the child's
self-esteem by making him or her feel like a baby; other parents claim that
the use of absorbent products gave their child a renewed sense of control
over the condition. Use of diapers or pull-on style products has not been shown to delay
gaining of control. If you use a product for your child, go shopping with
him or her for pajamas that will conceal the product.
- Try waking the child up at
regular intervals throughout the night to empty the bladder before it
becomes full to the point of leakage. This is a common approach and is
called “night waking.” It may not necessarily work: some children will
be wet before he/she is awakened or the child may wet after being taken to
the bathroom.
- Many people find great success
with the use of alarms that awaken the individual as soon as they begin
urinating during the night. Most alarm devices have a sensor end which is
tucked into the diapers or underwear. The other end is attached to the
pajama top or shirt. When wetting occurs, the alarm will both sound off
and/or vibrate. Alarms have no side effects and the lowest relapse rate, but
not every insurance plan will cover the cost.
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Type of Incontinence: Fecal Incontinence
Medical
Reviewer: Carrie Carls
, RN, BSN, CWOCN
Fecal incontinence, also called bowel incontinence, is when stool (also called
fecal matter) or gas unexpectedly leaks from your rectum. Sometimes you feel the
urge to have a bowel movement, but can’t reach a bathroom in time. The
National Institutes of Health reports that more than 5.5 million Americans have
fecal incontinence. As with urinary incontinence, fecal incontinence affects
people of all ages, races, and both sexes. However, it is more common in women than in men, and it affects the elderly more often than
younger adults (although it is not a normal part of aging).
In
some cases, incontinence of gas can almost be a bigger challenge than
incontinence of stool. Uncontrollable leakage of gas can sometimes cause a sound
and/or odor that can't be covered up, hidden, or managed with an absorbent
product.
Why?
Some causes for fecal incontinence include:
- Muscle and/or nerve damage due
to childbirth (including complications with episiotomies), surgery, spine or
pelvic trauma, or other trauma to the pelvic floor
- Constipation due to the
"overflow" that can occur when hardened stool becomes backed up
and unformed liquid stool seeps around the blockage
- Health conditions such as
Crohn's Disease or Ulcerative Colitis (Inflammatory Bowel Disease),
Irritable Bowel Syndrome, or neurologic conditions such as multiple
sclerosis (M.S.).
- Effects of medications or
treatments: regular and long-term use of laxatives can cause the bowel
muscles to weaken to the point that they lose control.
Radiation to the pelvis and/or bowels can affect the ability of the
rectum to store stool, leading to leakage.
- Diarrhea
Prevention
Good bladder and bowel health is an important part of taking care of
your body. Some things that everyone can do to help prevent fecal incontinence
include:
- Prevent constipation by making
sure you get enough liquids and fiber each day.
- If a health condition such as
Crohn's Disease or Irritable Bowel Syndrome is the cause, following your
doctor's recommendations for managing the condition can often help with the
incontinence as well.
- Reduce the risk of
incontinence by avoiding routine episiotomies during childbirth.
- Strengthen the muscles of the
pelvic floor that help support the anal sphincter by routinely doing pelvic
floor exercises (Kegels). Maintain adequate exercise for your whole body daily to help keep
the bowels working regularly.
- Avoid prolonged failure to
empty your bowels.
Treatment
and Management
Bowel incontinence can be very uncomfortable to talk about, however, it is
important for the sake of your health that you speak with a knowledgeable
medical professional. If your family doctor or general practitioner isn't
interested in treating fecal incontinence, you may want to make an appointment
with a gastroenterologist. In some cases, you may be referred to a colorectal
surgeon. Your exam will probably start with simply talking about your condition.
The doctor will want to know how often you experience fecal incontinence, and
when it has happened. He or she might also ask about family history. The doctor
will also probably want to do a physical exam, and possibly additional tests.
These questions and tests might be embarrassing, but there are treatment options
your doctor may be able to recommend after a thorough exam. Some of the
management and treatment options that you may want to discuss with your doctor
include:
There
may be other treatment options offered by your health care provider as well.
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Type of Incontinence: Functional
Incontinence
Medical
Reviewer: Mary
Ann Anichini, GNP-BC
Functional incontinence is urinary or fecal leakage that occurs when the urinary
or fecal body
systems, respectively, are physiologically working fine. It is the result of
mobility challenges with getting to the bathroom and removing clothing in a
reasonable amount of time.
Why?
Functional incontinence often occurs:
- When an individual is
adjusting to new mobility challenges, such as using a wheelchair for the
first time
- When an individual has
arthritis
Prevention
and Treatment and Management Techniques
Preventing, and treating and managing functional incontinence are often one in the same, as the best
treatment for this type of incontinence is preventing episodes from occurring in
the first place. Depending on the causes of the functional incontinence, the following may or may not be applicable:
- Follow a timed-voiding
schedule so that the bladder and bowel are emptied at predictable times,
before it becomes "too late".
- Leave the bathroom door open
and lights on at all times so it is easy to locate and access.
- Keep the pathway to the
bathroom as clear and open as possible.
- Use pants with an elastic
waistband rather than buttons or zippers.
- You may want to try using
absorbent products or, for men, you can try urine collection
devices, although
sometimes these products will hinder the individual from using a toilet.
- Have devices such as grab bars
and a raised toilet seat installed to enhance safe and efficient transfer to
the toilet.
Tips
and Tricks
Often caregivers, especially family caregivers, resist helping a person
struggling with incontinence because they don’t want to invade personal space
or take away the individual’s dignity. It can be uncomfortable assisting
someone to the toilet the first few times, but shortly you’ll realize that for
the person with incontinence, getting assistance preserves dignity much more so
than urinating on one’s self. Once the person is safely seated on the toilet,
try to provide as much privacy as possible. This is another important step in
preserving dignity, and it also helps facilitate quicker and more complete
emptying of the bladder and/or bowel (especially for individuals with a shy
bladder).
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Type of Incontinence: Mixed
Incontinence (Combination of SUI and Urge)
Medical Reviewer: Beth
Shelly PT, DPT, BCIA-PMDB
In some cases incontinence can be a combination of both
stress urinary incontinence (SUI) and urge incontinence. It is important to realize that if you have
mixed incontinence, but only treat one of the two types, you will still
have incontinence: both types of incontinence must be treated to see
desirable results. If you are diagnosed with either SUI or urge incontinence,
make sure that your doctor has ruled out the other type and that you do not, in
fact, have mixed incontinence. For more information about mixed incontinence,
please read about both stress incontinence and urge
incontinence.
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Type of Incontinence: Overflow Urinary
Incontinence
Medical
Reviewer:
Tamara Dickinson,
RN, CURN, CCCN, BCIA-PMDB
When you don't feel the urge to urinate, the bladder may become overfilled, and
urine may start to leak out. You may also not completely empty your bladder,
causing urine to back-up and overflow. This condition is called overflow
incontinence, or sometimes called “chronic retention of urine”.
Why?
Overflow incontinence often occurs as the result of a neurological
condition that affects the nerves of the bladder, such as a spinal cord injury. Overflow incontinence can also occur in people who have trouble feeling
when their bladder is full for reasons like diabetes or neuropathy.. Overflow
incontinence can also occur as the result of a blockage in the urethra or
bladder, including a tumor, scar tissue, or (in men) an enlarged prostate or (in
women) a dropped or prolapsed bladder. In both cases the bladder doesn’t empty well and continues to
fill, and over time the muscles of the bladder become overstretched and lose
some control.
Treatment
and Management Techniques
Overflow incontinence can be a sign or symptom of a neurological
condition or abnormal growth, so it is important that you seek medical diagnosis
and treatment. Some treatment and management techniques that you might discuss
with your health care professional include:
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Type of Incontinence: Stress Urinary Incontinence (SUI)
Medical
Reviewer: Beth Shelly PT, DPT,
BCIA-PMDB
Stress Urinary Incontinence (SUI) is the most common type of incontinence. The
"stress" in this incontinence refers to a physical stress that's
placed on the urinary system, such as a cough, sneeze, or laugh. About 50% of
women occasionally experience SUI. While women experience stress incontinence
more often then men, some men do experience it as well.
Why?
The muscles of your pelvic floor create a hammock that holds your
bladder and bowel in place (and in women, your uterus). One of the muscles in
this area is called a "sphincter". The sphincter surrounds and clamps
the urethra closed (the urethra is the hollow tube that leads urine out of the
body from the bladder). As the pelvic floor muscles weaken or become damaged,
the sphincter can lose it's ability to completely clamp the urethra closed,
especially when you experience a physical stress due to coughing, laughing, or
sneezing. When this happens, any amount of urine from a few drops to the entire
content of your bladder can leak.
Men
generally experience SUI following the treatment of enlarged prostate or
prostate cancer. Some contributing factors to SUI in women include pregnancy,
menopause, and hysterectomy. Smoking and
obesity can exacerbate stress
incontinence in both men and women.
Prevention
Stress incontinence is best prevented by strengthening the pelvic floor
muscles with pelvic floor exercises. These exercises are especially important
before and after prostate surgery in men, and childbirth and hysterectomy in
women. It can be difficult to identify the correct muscles to exercise, and
people often do the exercises incorrectly without realizing it, so you may want
to check with a doctor or nurse. Smoking and obesity
have both been linked with SUI, so not smoking and maintaining an ideal body
weight both may help prevent incontinence.
Treatment
and Management Options
While you may assume that you're experiencing stress urinary
incontinence if you leak while exerting physical stress, it is always important
to seek medical help for two reasons: 1) your doctor can rule out any other
causes that may require treatment and; 2) stress incontinence is highly
treatable! The following treatments are recommended for stress urinary
incontinence:
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Type of Incontinence: Urge Incontinence or Overactive Bladder
(OAB)
Medical
Reviewer: Karen
Sasso, MSN, RN, APN, CCCN
Overactive bladder (OAB) is a condition in which
the bladder can spasm and cause a sudden, intense and frequent urge to urinate.
In some cases, these urges can lead to episodes of involuntary urine leakage,
which is called urge urinary incontinence (UUI) or UUI-wet. Overactive bladder
contractions that send you running to the bathroom quite frequently, without any
leakage is referred to as UUI-dry.
Why?
The bladder is a muscle, and like all muscles it is controlled by
nerves. As the bladder fills, the nerves sense the fullness and send a signal to
your brain telling you that you need to urinate. Usually, your body responds to
this urge to urinate so that you'll have enough time to get to the bathroom.
When you are at the toilet, your
brain will send the message to your bladder that it is now appropriate to
urinate. The message sent to the bladder tells the detrusor muscle (the bladder
muscle) to contract and expel the urine. When you have OAB, the nerves alert you
that you need to urinate, but your ability to inhibit this urge is compromised
and then the bladder starts to spasm on its own and push the urine out. The
amount of urine leaked varies. Some people have overactive bladder without any
incontinence - they simply feel frequent and intense urge to urinate, but always
make it to the bathroom in time. However, many people leak anywhere from a few
drops to the entire content in their bladder when the urgency strikes.
Prevention
In most cases no one is quite sure of the cause of OAB or urge urinary
incontinence. A strong pelvic floor muscle contraction during urgency can
suppress an involuntary bladder contraction and
prevent urine from leaking. Having good pelvic floor muscle
tone by doing pelvic floor exercises can only help with urge suppression and
the control of involuntary urine leakage.
Treatment
and Management Techniques
Keeping in mind that overactive bladder and urge incontinence are
affected by the functioning of your nerves, it is always important to seek
medical diagnosis and treatment: a qualified doctor can run the appropriate
tests to rule out any other underlying cause. An interested and qualified
medical professional can also help you to find a treatment and management plan
that works for you. Some suggestions to discuss with your doctor include:
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Treatment
and Management Techniques
Absorbent Products (including products
commonly called "adult diapers")
Artificial Sphincter Surgery for Fecal
Incontinence
Artificial Sphincter Surgery for Urinary
Incontinence
Avoiding Bladder Irritants
Biofeedback
Bladder Retraining
Botulinum Toxin Injections
Bowel Retraining
Catheterization
Dietary Changes for Fecal Incontinence
Electrical Stimulation of the Pelvic Floor
Experimental Treatment with Stem Cells
Fiber Therapy
Hormone Replacement Therapy (HRT)
Injection of a Bulking Agent
Insertion of a Pessary
Medication or
Laxative Use for Fecal Incontinence
Medications for
Overactive Bladder (OAB)
Pelvic Floor Exercises (including Kegels)
Sacral Nerve Stimulation
Surgery for Pelvic Organ
Prolapse
Surgery for Stress
Urinary Incontinence (SUI)
Urine Collection Devices for Men
Vaginal Weights or Cones for Women
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Absorbent Products
(including products commonly called "adult diapers")
Medical Reviewer: Mary
Ann Anichini, GNP-BC
Absorbent products refers to a category of products that absorb urine, including
what most people refer to as "adult diapers". These products come as
either disposable or reusable products designed for both men and women of all
ages and sizes. In addition to simply disposable or reusable, there are a
variety of different types of absorbent products, including "panty
liner" styles, full briefs, and booster pads (which can be placed as a
liner inside of a brief). Absorbent products are not a treatment of
incontinence, but rather a management tool.
Who?
Most people who have experienced incontinence of any kind have used
absorbent products at one time or another. If you are using absorbent products,
it is always important to speak to a medical professional about incontinence so
that they can properly rule out any serious underlying cause, and help you find
the treatment option that works best for you. Sometimes there may not be an
appropriate treatment option available, and therefore you might choose to
continue wearing absorbent products. Often occasional or slight leakage may
occur even after treatment, and thus some sort of protection may still be needed
on an ongoing basis (as often happens when on medication or after a surgery for
the treatment of incontinence).
The
Pros
- Absorbent products can be
bought at a local drugstore or through a home-delivery service.
- The products offer the
security of knowing that should leakage occur, something is in place to
absorb it.
- For some people with
incontinence, absorbent products are a more appealing option than surgery or
medication.
The
Cons
- There is an ongoing cost
associated with using products.
- You may feel self-conscious
using the products due to possible bulkiness or noise.
- Many people feel embarrassed
buying the products.
Tips
and Tricks
Use the Right Product
There are many factors to consider when choosing an absorbent product:
flexibility for your activity level; products for men or for women; size;
absorbency level; disposable vs. reusable. Take all these factors into
consideration when looking for a product. You might even find that one product
is best for at night, another for working at your desk during the day, and a
third for being out and active, like playing golf or going for walks. Try not to
look at the price tags first and instead choose based on your needs - you might
even find that a more expensive product will give you better coverage and thus
cost you less in the long run.
About
"Booster Pads"
Booster pads can be purchased as liners for absorbent briefs, increasing the
absorbency and protection. It's important to note that unlike regular pads,
boosters don't have a waterproof backing. After the booster fills to capacity,
the overflow will flow thru to the absorbent brief beneath.
About
Skin Care
Keeping the skin that comes into contact with urine or a bowel movement
clean and dry is important. When changing absorbent products wash the perineal
area with mild soap (not deodorant) and warm water, then pat the skin dry
(do not rub). Application of a skin ointment can further protect the skin.
Avoid
Using Menstrual Pads
Many women use menstrual pads when they begin to experience incontinence.
Menstrual pads aren't designed to absorb urine and don't provide the coverage
and protection that pads designed for incontinence will provide.
Shop
from Home
Often, people are embarrassed to purchase absorbent products at their
neighborhood drug or grocery store. You may want to consider using a service
that delivers these products to your home. They usually come in an unmarked box,
and sometimes the company will mail you free or low-cost samples if you ask.
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Artificial
Sphincter Surgery for Fecal Incontinence
Medical
Reviewer: Christine Norton,
PhD, MA, RN
Everyone
has a pelvic floor: it is a hammock of muscles that lies in your pelvis,
supporting the organs (bowel, bladder, and - in women - the uterus) in that area
and keeping them in the correct place. In your pelvic floor are a few muscles
that are called "sphincters". There is an internal and external
sphincter surrounding the anus. These anal sphincters naturally contract around
the rectum and keep the fecal matter inside your body until you relax the
sphincters at a socially-acceptable time (generally when you're using a toilet).
As the urge to defecate increases, you can contract your sphincters to gain more
control.
Surgery
to implant an artificial sphincter involves placing an inflatable sphincter
around the anus. A pump (placed inside the body in the labia or scrotum) is used
to deflate the device, allowing fecal matter to pass through at the appropriate
time. The device automatically refills after ten minutes, once again closing off
the rectum.
Who?
Men or women with fecal incontinence following sphincter damage may be
interested in this surgery. Sphincter damage can occur as the result of
episiotomy, childbirth, or treatment of prostate cancer.
The
Pros
- There are relatively few
treatment options available for fecal incontinence. When other treatments
haven't been successful, some individuals feel that the potential benefits
of this surgery outweigh the risks.
The
Cons
- This surgery has a relatively
low success rate, and a review done by the Cochrane Collaboration (a
well-respected group which reviews medical studies) found that there was not
enough evidence to determine that surgery for fecal incontinence does more
good than harm when compared to non-surgical interventions.
- As with any surgery, there are
certain risks associated, especially the risk of infection.
- There is a risk of tissue
erosion at the site of the implant.
- There are high rates of
complications and device malfunction associated with the implantation of an
artificial sphincter for the treatment of fecal incontinence.
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Artificial
Sphincter Surgery for Urinary Incontinence
Medical
Reviewer: Marcus Drake, M.D.
Everyone has a pelvic floor: it is a hammock of muscles that lies in your
pelvis, supporting the organs (bowel, bladder, and - in women - the uterus) in
that area and keeping them in the correct place. In your pelvic floor are a few
muscles that are called "sphincters". There is an internal and
external sphincter surrounding the urethra (the tube that takes urine from the
bladder out of your body). These urinary sphincters naturally contract around
the urethra and keep the urine inside your body until you relax the sphincters
at a socially-acceptable time (generally when you're using a toilet). As the
urge to urinate increases, you can voluntarily increase the contraction of your
sphincters to gain more control.
Surgery
to implant an artificial sphincter involves placing an inflatable cuff around
the bladder neck above the pelvic floor. In men, the cuff can also be placed
below the pelvic floor in the bulb of the urethra (just behind the base of the
scrotum) A pump (placed inside the body in the labia or scrotum) is used to
deflate the cuff, allowing urine to pass through at the appropriate time for
passing urine. The fluid pumped from the cuff goes into the third component of
the device, which is an elasticized reservoir balloon; this slowly returns the
fluid to the cuff, so it automatically refills after a couple of minutes, once
again closing off the urethra.
Who?
Men or women with stress incontinence following sphincter damage may be
interested in this surgery. Sphincter damage can occur as the result of prostate
surgery, episiotomy, or childbirth. People with neurological disease
affecting sphincter function may also consider artificial urinary sphincter
placement.
The
Pros
- This surgery provides a
possible treatment option for those who have experienced sphincter damage..
The
Cons
- As with any surgery, there are
certain risks associated, especially the risk of infection.
- Not everyone is cured with
this treatment.
- There is a risk of tissue
erosion at the site of the implant.
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Avoiding Bladder Irritants
Medical Reviewer: Diana
Hankey-Underwood, MS, WHNP-BC
There are a number of foods and drinks that most people use every
day that can irritate the lining of the bladder. These foods and drinks may cause people with sensitive bladders to have
to go to the bathroom more often and need to get to the bathroom sooner.
Sometimes this may cause incontinence.
An
easy way to check if any food or drink is causing bladder problems is to do a
special diet, called an “elimination diet”. Stop eating and drinking all the
things listed below for two weeks. Also take out any other foods or drinks that
you think may be causing a problem.
If
your bladder gets better, then begin to add back to your diet one product each
week. If you notice your bladder is acting up, stop using the product that you
just added back. Wait two weeks before adding any of the other products. Then,
start again to add one thing at a time.
Possible
bladder irritants are:
- Caffeine (often in coffee,
tea, iced tea, soda, and chocolate)
- Carbonated beverages
- Coffee (including decaf)
- Citrus fruits (orange, lemon,
lime, grapefruit, etc.)
- Fruit juices
- Alcoholic beverages
- Milk, yogurt and other dairy
foods
- Cranberries and cranberry
juice
- Apples and apple juice
- Spicy foods
Who?
It is hard to
stop eating and drinking things we love, but it isn’t painful and it doesn’t
cost anything, so most people with incontinence are encouraged to try it.
If something that you are eating is the main problem, other drugs and surgery
may not help, so it is best to see if this could be part of the problem.
The
Pros
- There is no cost, other than
finding and buying new foods and drinks.
- The
diet is completely non-invasive and can be done at your own pace.
The
Cons
- While avoiding bladder
irritants can help, sometimes it doesn’t stop all leaking.
- It may be hard to go without
eating or drinking something that you like.
- It may be hard to go without
things that you have a habit of using, like caffeine.
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Biofeedback
Medical Reviewer: Diana
Hankey-Underwood, MS, WHNP-BC
Biofeedback is used to treat many conditions such as headaches,
high blood pressure, and incontinence. Biofeedback helps you learn how to
control certain functions in the body. You
can get information from a machine that translates body functions into pictures
or numbers to help you learn to do this.
Biofeedback
is done in a medical office. You are given a small sensor to place in the vagina
or anus. The probe senses what your muscles are doing and sends a signal to a
computer screen. The display on the screen might be something like a colored
ball. As you squeeze your pelvic floor muscles, the computer shows the ball
becoming bigger or smaller. By watching the display you learn how to do the
pelvic floor exercises correctly. There are machines that you can use at home
after you begin to learn how to do this. Some do not use computers and are not
very expensive.
Who?
Using biofeedback machines you can learn how to do pelvic floor exercises the
right way. Doing these exercises will make your entire pelvic area stronger.
These exercises sound simple, but many people do not do them the right way
without biofeedback or an expert showing them how. Biofeedback can really help
people with stress incontinence.
The
Pros
- You get one-on-one attention
from a trained professional.
- He or she can help you learn
how to do the exercises correctly.
- He or she can share ideas
about how to cope because they work with many people with the same problem.
- If you have a hard time
remembering when to do your pelvic floor exercises, this training will help.
- If you are a person who learns
best by seeing, biofeedback can be a big help.
The
Cons
- Not all insurances pay for
these services. Some people don’t have any insurance and the cost may be
too high.
- Some people find the idea of
inserting a probe to be too embarrassing.
- Keeping a regular schedule and
doing what you are told is the only way to get better.
- Getting better takes time and
most people get better a little bit at a time.
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Bladder
Retraining
Medical
Reviewer: Diana
Hankey-Underwood, MS, WHNP-BC
The first goal of bladder retraining is to empty your bladder before
you leak. The second goal is to begin to train your bladder to hold more urine
for longer periods of time. Bladder training is usually safe, but you should see
a health care provider to make sure that you don’t have a bladder infection
before starting bladder retraining.
There
are a few different ways to retrain the bladder. One of the easiest ways is to
begin by urinating every hour, on the hour.
(If you can't hold it for one hour, pick a time that you can easily
manage such as twenty or thirty minutes.) Go
to the bathroom and try to empty your bladder at regular times all day while you
are awake. Each week, gradually
increase the time between voiding by 15 minutes. Continue to do this until you
reach a length of time that is reasonable for your lifestyle and healthy for
your body. Do not try to hold your
bladder for
more than four hours at a time.
Who?
Bladder retraining is a non-invasive treatment that can be used for many
types of urinary incontinence. It works best for people with bladders that want
to go all the time (we call that
overactive bladder - if the urge leads to leaking, it is called urge
incontinence). It also works very
well for people who have to go to the bathroom more than 6 times a day and who
leak when they sneeze or cough (called mixed incontinence, because it is a mix of both stress urinary
incontinence and urge incontinence).
The
Pros
- Bladder retraining doesn’t
hurt and almost anyone can try it (although it might be hard for people who
can’t move quickly).
- If you start bladder
retraining and you don't like it, you can just stop.
The
Cons
- Not
everyone can achieve complete dryness and absorbent products still may need
to be worn.
- It
takes weeks to get better.
- It
takes a lot of mental focus to remember to go to the bathroom on time.
- Bladder
retraining works by going to the bathroom at just the right time every day,
but if there is a change like being stuck in traffic, there may still be
leaking. You can’t always
predict what will happen, so the worry is still there and you may still have
to wear special protection.
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Botulinum
Toxin Injections
Medical
Reviewer: Catherine
DuBeau, M.D.
Botulinum toxin, often used in cosmetic procedures, is currently being studied
as a treatment for severe urge incontinence that has not responded to medical
therapy. In this treatment, botulinum toxin is injected directly into the
bladder muscle, relaxing it and allowing the bladder to fill with more urine
before the urge to urinate strikes. It has been found that after botulinum toxin
injections some persons are unable to pass urine at all. Therefore, all persons undergoing this treatment must be prepared to use
a catheter to empty their bladder if this side effect occurs. Botulinum toxin injection in the bladder is still experimental and has
NOT been approved by the FDA. Studies
are still needed to determine the amount of botulinum toxin to inject, which
persons are more likely to have problems passing urine after treatment, and how
long the treatment lasts.
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Bowel
Retraining
Medical
Reviewer:
Carrie Carls
, RN, BSN, CWOCN
Consistent bowel movements are crucial to obtaining fecal continence. To retrain
your bowel to empty on a regular and consistent basis, begin by increasing fiber
and fluid intake (see dietary changes for fecal
incontinence, and fiber therapy). Then, set a daily time to empty your
bowels that you can stick to (about 20 to 40 minutes following a meal). Every
day at the set time, sit on a toilet or commode (or use a bedpan if unable to
walk) and relax and empty the bowel by bearing down and contracting the stomach
muscles. If unable to have a bowel movement in this way, you may want to speak
to your health care professional about a technique called digital stimulation,
or by performing an enema just before a desired bowel movement. By increasing
your fiber and fluids, and sticking to your scheduled bowel movement time each
day, you may find that your bowels begin emptying on their own again.
Who?
Bowel retraining is useful for anyone experiencing constipation, which
can cause fecal and/or urinary incontinence.
The
Pros
- Like fiber therapy and bladder
retraining, bowel retraining is a non-invasive treatment that may bring
results without the need for more serious interventions.
The
Cons
- Not everyone can achieve a
regular bowel schedule through this method, and those who do still may not
experience complete continence.
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Catheterization
Medical
Reviewer: Kristene Whitmore,
M.D.
There are three types of catheterization: indwelling (sometimes called a
Foley), suprapubic, and clean intermittent catheterization (CIC).
Catheterization prevents a difficult-to-empty bladder from becoming overly full
and backing up into the kidneys, thereby preventing kidney damage.
Clean
Intermittent Catheterization (CIC)
CIC is a procedure in which you learn to catheterize yourself when you need to
urinate, by inserting a catheter into your urethra, usually about four times per
day. The catheter is inserted and then the
bladder is drained until it is time to urinate again. Clean intermittent
catheterization is usually used by individuals who have difficulty emptying
their bladder due to having a neurogenic bladder.
Because a foreign object (the
catheter) is being inserted into the urethra, there is a chance of introducing
bacteria into the urinary tract, which leads to greater instances of urinary
tract infections. To reduce the risk of infection, be very careful to always
keep the catheter free of bacteria and perform catheterization under the
cleanest conditions possible. Because CIC drains the bladder, completely
removing residual urine, it causes fewer urinary tract infections than using an
indwelling catheter and it is usually the first choice of the three options when
catheterization is necessary (aside from during surgery, when an indwelling
catheter is used).
It can be challenging for some people to learn
self-catheterization if they are hesitant about the procedure (although many
people learn the procedure quickly and easily). Anyone attempting to learn
self-catheterization should do so under the guidance of a qualified medical
professional. There are a variety of different catheters available. Each
catheter has its own advantages and disadvantages. Talk to your medical
professional for his or her advice, and try several different options to find
the safest and most comfortable option for you.
Indwelling
(or Foley) Catheter
An indwelling catheter is a thin tube inserted into the urethra for
long-term use. The catheter drains urine into a bag that is either attached with
a strap around a leg underneath pants or a skirt so that you can be active
during the day, or it is hung from the side of a bed (generally used at night,
or for those who remain in a bed for long periods of time). Indwelling catheters
are often used during many medical procedures, including most surgeries,
regardless of whether or not the individual has incontinence. Also, in some
cases of constant urine leakage an indwelling catheter is used. If left in place
for long periods of time, infection may occur.
Suprapubic
Catheter
A suprapubic catheter is a catheter that is surgically implanted through a small
cut made in the abdomen (above the pubic bone). A
doctor or nurse replaces the catheter regularly - about once a month. As with
the indwelling catheter, the tube drains urine from the bladder into a bag. A
suprapubic catheter is used in individuals requiring long-term catheterization,
especially in cases making CIC or an indwelling urinary catheter difficult.
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Dietary
Changes for Fecal Incontinence
Medical
Reviewer: Carrie Carls
, RN, BSN, CWOCN
Foods that commonly contribute to diarrhea and bowel incontinence are chocolate,
dairy products, alcohol, and caffeine. Try
decreasing the amount of these foods consumed to see if it improves the
consistency of bowel movements. In
addition to fiber therapy, other dietary
measures may include undergoing an elimination diet to see if certain foods
trigger incontinence of stool.
An
elimination diet can be done by keeping a diary/notebook to track all foods and
fluids consumed over a seven day period. The
diary would also track the volume and consistency of bowel movements, and any
symptoms such as cramping or gas. After
seven days, review the diary to see if any patterns emerge, showing foods that
trigger looser bowel movements or incontinence. Those foods should be eliminated
from the diet for two weeks, while continuing to keep the diary. Next, you can add the offending foods back one at a time for
three days to
see if they cause bowel symptoms. If
so, eliminate the foods completely.
If
you find in your food diary that after consuming foods that contain gluten you
experience diarrhea, cramping, or pain, contact your health care provider, as
you may have a condition called celiac disease. Gluten is a protein found in
most
cereal grains (wheat, rye and barley), and is in most bread, cake, and
baking mixes, pie crusts, gravy and seasoning mixes, pancakes, waffles, and some
canned foods.
Who?
Anyone
capable of keeping a written record or who has a care giver to keep the record
can complete a food diary to determine if dietary changes are necessary. Because
this is a non-invasive treatment method, most people with fecal incontinence are
encouraged to try it.
The
Pros
-
Determining dietary triggers to bowel incontinence allows some
control over the condition.
-
There is no cost involved, other than replacing the foods and
drinks you might normally drink with something new.
-
This method is completely non-invasive and can be done at your own
pace.
The
Cons
-
Carrying out the process for the elimination diary
requires at least four weeks of record keeping.
-
While dietary changes can help your symptoms, it often doesn't
prevent leakage entirely.
-
It may be challenging to go without a food that you've become
quite accustomed to.
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Electrical
Stimulation
Medical
Reviewer: Diana
Hankey-Underwood, MS, WHNP-BC
During electrical stimulation (or e-stim for short), sticky pads
are stuck to the skin around the vagina or a little piece of plastic is placed
into the vagina or rectum. A
small amount of electricity goes into this and makes the muscles move and
contract.
These
contractions are exercises for the pelvic floor muscles. With the exercises, the pelvic floor muscles can get stronger just like
an arm muscle that gets regular exercise. E-stim
is usually started by a doctor, nurse practitioner, nurse or physical therapist. He or she will work with you one or more times per week for several
weeks. They usually do biofeedback
at the same time, but not always.
Who?
E-stim is useful for men and women who would benefit from pelvic
floor exercises due to stress incontinence, or as a preventative step before
prostate treatment. Electrical stimulation is especially beneficial in
individuals who can't contract their pelvic floor muscles on their own due to
weak muscle control.
The
Pros
- Individuals with very weak
pelvic muscle control can still gain the benefits of pelvic floor exercises.
- This is a less-invasive
treatment than surgery.
The
Cons
- You may find the treatment
embarrassing or too invasive.
- The treatment can be
time-consuming and the results aren't instant.
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Experimental Treatment with Stem Cells
Medical Reviewer: Catherine
DuBeau, M.D.
Scientists have begun to study whether stem cells found in a patient's arm or
leg can treat stress urinary incontinence in women. Stem cells can grow into muscle and other types of cells. In early experiments, doctors removed a small amount of leg muscle and
sent it to a lab where researchers isolated and grew the stem cells. A few weeks
later the stem cells were injected into the patient’s urethra, helping to
strengthen bladder control and prevent leakage. Early results are promising, but
much more work needs to be done to know whether this treatment will be
effective, if there are any side effects and what are they, how long any benefit
from treatment lasts, which patients would be most likely to benefit, and the
cost of the treatment.
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Fiber
Therapy
Medical Reviewer: Carrie
Carls
, RN, BSN, CWOCN
Fiber absorbs liquids in the digestive system, thereby bulking up fecal
matter. It is recommended that women younger than fifty consume 25 grams of
fiber per day, and older than fifty consume 21 grams per day. Men younger than
fifty are recommended to get 38 grams per day, and older than fifty should get
30 grams per day. The average American, however, only has about 15 grams of
fiber per day in their diet. Fiber therapy is simply increasing your fiber
intake gradually until you reach the recommended daily intake. Because fiber has
such a great impact on your digestion of food, it is important that you increase
your daily fiber gradually. Remember that fiber absorbs liquids in your body, so
also increase your water intake as you increase your fiber. Increasing water intake along with fiber also helps to prevent
possible side effects of gas and bloating.
How
to get more fiber in your diet:
- Eat more whole grains (replace
"white" pastas, cereals, and breads with whole grain varieties).
- Eat more beans, occasionally
substituting them for meat.
- Use fiber supplements.
Who?
Fiber therapy is a non-invasive treatment that can be attempted by
nearly anyone experiencing fecal incontinence. Fiber can help alleviate fecal
incontinence by absorbing water and bulking up the fecal matter. Fiber therapy
can also relieve constipation, which can also cause fecal incontinence (by
causing liquid stool to leak out around a blockage).
The
Pros
- As long as you increase your
fiber intake gradually, getting the recommended daily dose usually doesn't
hurt anything (unless you have allergies that make you sensitive to
fiber-containing foods), so it's generally worth trying.
- Fiber is associated with
lowering certain health risks, such as heart disease.
The
Cons
- Fiber can cause bloating,
diarrhea and flatulence (gas), especially when increased too quickly in the
diet or when over-consumed.
- While fiber may help to
alleviate incontinence, it usually doesn't cure it completely, so
other treatment or management may be necessary.
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Hormone
Replacement Therapy (HRT)
Medical Reviewer: Catherine
DuBeau, M.D.
Hormone Replacement Therapy (HRT), also called
Estrogen Replacement Therapy (ERT), is most commonly given to women during or
after menopause to help alleviate the symptoms of menopause. HRT and ERT are not
effective to treat incontinence, and several studies demonstrate that estrogen
causes or worsens urinary incontinence in postmenopausal women.
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Injection
of a Bulking Agent
Medical
Reviewer: Karen
Sasso, MSN, RN, APN, CCCN
In this outpatient procedure a bulking agent is injected into the neck of the
bladder to bulk it up and help compress the urethra (the tube that leads urine
out of the body).
Who?
This procedure can be used on men or women with a non-severe type of
stress urinary incontinence, often as the result of prostate surgery or
childbirth (respectively).
The
Pros
- This treatment is less
invasive than surgery.
- Many people have great success
with this treatment.
- Injections of biocompatible
material are a short-term solution, so they may be ideal for treatment of
this type of incontinence from the damage to the urethra after childbirth or
prostate surgery.
The
Cons
- The injections must be
repeated anywhere from every couple of months to once a year.
- Most people get significant
reduction in their urine leakage associated with activity but may need to
wear some protection.
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Insertion
of a Pessary
Medical
Reviewer: Catherine
DuBeau, M.D.
A pessary is a small device made of rubber, plastic, or silicone, often shaped
like a doughnut, that is inserted into the vagina to help support the pelvic
floor. Pessaries are used to treat pelvic floor or organ prolapse, and
incontinence that is felt to be related to existing prolapse.
A health professional fits you for the product, and then you either learn
to insert, remove and clean the pessary yourself, or you return to the doctor
for periodic removal and cleaning.
Who?
Pessaries are used by women to help support the bladder and urethra.
They are used by women with pelvic organ prolapse, including a cystocele,
rectocele, and/or a dropped bladder or uterus.
The Pros
- Pessaries are completely
removable if another treatment becomes available down the road.
- Pessary use carries less risk
than surgery.
- When properly fit, a pessary
is comfortable to wear.
The
Cons
- Some women are uncomfortable
with the thought of being fit for a pessary, inserting and removing the
pessary on their own, or having a doctor insert or remove the pessary.
- Women who are sexually active
need to remove the pessary before intercourse
- Infection can occur if the
pessary is not removed and cleaned properly.
- Irritation can occur, especially in post-menopausal
women (due to lack of estrogen and natural lubricant). However, this can usually be successfully treated with creams.
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Medication
or Laxative Use for Fecal Incontinence
Medical
Reviewer: Carrie Carls
, RN, BSN, CWOCN
Certain medications and laxatives can be used either to bulk up stool (in the
case of diarrhea) or soften stool (in the case of constipation - overflow
diarrhea and incontinence can occur as the result of constipation).
Who?
Medications and laxatives can be used to treat a variety of different
types of fecal incontinence and should always be discussed first with a
doctor.
The
Pros
- Medications and laxatives are
less invasive than surgery.
- Medication can be stopped at
any time if the desired results are not achieved or the side-effects are
undesirable. However, long-term laxative use, especially without
professional medical guidance, may cause ongoing damage.
The
Cons
- Without proper oversight by a
medical professional, long-term use of laxatives can actually cause
incontinence by causing the bowel to become inactive, or causing
constipation following laxative-induced diarrhea or loose stools (the bowel
becomes dried-out).
- Long-term laxative use can
become habit-forming and cause dependency.
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Medications
for Overactive Bladder (OAB)
Medical
Reviewer:
Tamara Dickinson,
RN, CURN, CCCN, BCIA-PMDB
All pharmaceutical medications currently available on the U.S. market for the
treatment of incontinence are specifically for a condition called overactive
bladder, or OAB. You may have seen advertisements on television or in
magazines for these medications. The medications for overactive bladder block,
to some extent, the nerves that cause the bladder to spasm and contract,
reducing the frequency and severity of the overwhelming urge to urinate.
Who?
These medications are for individuals with overactive bladder. There are
some side affects associated with the medications that affect some people more
than others - however, the side effects differ amongst the specific drugs (so,
while you may not like the side effects of one medication, you may find another
OAB drug doesn't have that affect on you). The most common side effects include
constipation, dry mouth and dry eyes. Many doctors recommend that individuals
with overactive bladder try a medication to see if they are affected by the side
effects. If you ever want to stop a prescribed medication, it is important that
you first speak with your doctor about that decision.
The
Pros
- Taking medication is not an
invasive treatment, and one that can be stopped at any time (with your
doctor's knowledge) if you don't like the results.
- Many people find great success
taking a medication.
- There are many different
medications available, so if one doesn't seem to work, or has adverse side
effects, your doctor may be able to recommend and prescribe a different
medication that might work better for you.
The
Cons
- The medications are not a
"cure" - they will only help the incontinence and urgency for as
long as you take the medication.
- There are side effects
associated with many of the medications.
- There is the ongoing cost of
paying for a prescription each month.
- In many cases the medication
will reduce your leakage and/or the extreme urgency to urinate, but may not
stop it completely, so you may still need to use some protection.
Tips
and Tricks
There are many medications available for overactive bladder, and they
each work slightly differently and have slightly different side effects. If
you're unhappy with the medication you are taking, it's important to speak with
your doctor. He or she can advise if you're taking the medication correctly, in
the right dosage, and if you've tried it long enough to see the effects. If your
doctor knows what the problem is, he or she may be able to recommend a different
medication that may provide you with better results.
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Pelvic Floor Exercises
Medical Reviewer: Diana
Hankey-Underwood, MS, WHNP-BC
Everyone has a pelvic floor. The
pelvic floor is a group of muscles that form a hammock shape in your pelvis.
Pelvic
floor muscles hold up the pelvic organs and keep them in the right place.
In women these organs are the uterus, bowel and bladder.
In men the same muscles hold the bowel and bladder. The muscles of the pelvic floor can become weak and can start to sag. This can happen because of injuries,
pregnancy, childbirth, or surgery
(including surgery for prostate problems and hysterectomies).
The muscles can also become weaker from carrying extra
weight, or from
chronic coughing.
When
you cough, laugh, sneeze, run, or do other physical activities, pressure is
added on the pelvic floor muscles. If they aren't strong enough to keep your
bladder or your bowel in place, you may leak during these times of physical
stress. This is what we call stress
urinary incontinence, or SUI. Leaking
from the bowel is called fecal incontinence. Pelvic floor exercises make the pelvic floor muscles stronger and this
can help you have more control over leaking during times of physical stress,
such as laughing, coughing, or sneezing.
How?
Because
many people have trouble finding their pelvic floor muscles, pelvic floor
exercises work best when taught by a professional, such as a physical therapist,
an enterostomal therapist, or a urology nurse. Make sure whoever you go to has a special interest and training in pelvic
floor exercises. A skilled health professional can help you find the right
muscles and exercise them the right way.
To
try to find one of the muscles on your own, simply stop the flow of urine the
next time you are going to the bathroom. Stop the flow only for a second or two,
until you understand the feeling, but don't make a habit of doing it each time
you go to the bathroom because it isn't healthy for your bladder and urethra
(the tube that leads urine from your bladder out of your body). When you squeeze to stop the urine, you are contracting the muscle called
the sphincter. When doing pelvic
floor exercises, you want to remember to only contract the sphincter
muscle. Do not contract your
stomach, legs or the outside cheeks of your bottom. There are a number of tools
and programs that can help you do pelvic floor exercises. Some men and women use
biofeedback. Women can use vaginal weights or
other plastic vaginal exercisers.
Who?
Pelvic floor exercises are great for people who have stress urinary
incontinence (SUI). They also help many people who have stress incontinence and
who have a bladder that makes them feel like they have to go to the bathroom all
of the time. This is called “mixed incontinence” because it is a mix of
stress incontinence and urge incontinence or overactive bladder (OAB).
These
exercises are also a wonderful thing to do to keep from getting leakage problems
in the future. Women can do them before, during, and after pregnancy. The
exercises can also help men who are getting treatment for enlarged prostate (BPH)
or prostate cancer.
The
Pros
- The exercises are easy once
you learn how to do them.
- You can try the exercises, and
if they don’t work you can always try another treatment, like surgery,
later.
- Many people get wonderful
results and say that it changed their lives for the better.
- After you spend money to get
trained in how to do the exercises correctly, it doesn’t cost very much to
keep doing them. You can just do the exercises on your own. The only cost might be new vaginal weights or cones if you want to
buy new ones, and if you choose to use them.
The
Cons
- These exercises don't work for
everyone.
- Many people will find some
benefit from the exercises, maybe even a lot of help, but they still leak a
little, so they still have to buy and wear some protection.
- It can take six to eight week
to start noticing results.
Tips and Tricks
Make sure that you see a medical professional for an
examination and to learn the correct way to do the exercises. Your medical
provider may suggest physical therapy and biofeedback. You may be asked to use vaginal cones or weights. You should try all of the suggestions and do all of the exercises because
you will get the best results this way.
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Sacral
Nerve Stimulation
Medical
Reviewer: Carrie Carls
, RN, BSN, CWOCN
Sacral nerve stimulation (SNS), also called sacral neuromodulation, involves
surgical implantation of a device that sends a low-voltage electrical current to
the sacral nerve (a nerve located at the base of the spine that affects the
bladder, bowel, and pelvic floor) to stimulate the nerve and thus alleviate
fecal and/or urinary incontinence. A hand-held programmer is used to stop the
contraction of the sphincter muscles when you need to empty your bowels.
Who?
Adult
patients experiencing urinary incontinence due to retention (overflow
incontinence) and/or overactive bladder with urge
incontinence, and individuals with
fecal incontinence and/or chronic constipation who have failed other treatments and are able to operate the hand-held
programmer may benefit from the stimulator. Other medical conditions may prevent safe use of the stimulator; ask your
doctor if you are a candidate.
The
Pros
-
For fecal incontinence or chronic constipation, use
of the sacral nerve stimulator may result in improvement in your ability to
delay emptying your bowels, decrease the number of episodes of bowel
incontinence, and improve your quality of life.
The
Cons
-
As with any surgical procedure, there is a risk of
infection or complications from anesthesia or the device implanted.
-
The stimulator may be affected by pacemakers for the heart,
ultrasonic equipment, radiation therapy, magnetic resonance imaging (MRI), theft
detectors and screening devices, and other devices.
-
Although most studies on this treatment seem to have generally positive
results, they are usually done on relatively small sample sizes.
-
This treatment helps to manage incontinence, but doesn't cure it. If the
product is removed at any point, or stops working, incontinence will still
remain.
-
This treatment may not make you completely dry at all times, and you
still may need to wear an absorbent product.
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Surgery
for Pelvic Organ Prolapse
Medical
Reviewer: Karen
Sasso, MSN, RN, APN, CCCN
There are several different types of surgeries performed for the treatment of
pelvic organ prolapse. The kind of surgery used is dependent on the type of
prolapse (bladder, womb or end of vagina, uterine, or bowel) Sometimes, when the
patient is experiencing stress urinary incontinence, the surgeon can perform an
anti-incontinence surgery, (most likely a loose sling under the neck of the
bladder) during the prolapse surgery for treatment of stress urinary
incontinence.
There are two main categories of surgery for prolapse: obliterate
and reconstructive. In obliterate surgery the vaginal opening is closed
completely. While this surgery is less invasive than reconstructive, there is no
possibility of intercourse following obliterate surgery. It is done in women who
are at surgical risk of complications from the anesthetic or the surgical
procedure. Reconstructive surgery,
which is much more commonly performed than obliterative surgery, is a longer and
more invasive procedure, but the goal is to restore the anatomy, resolve the
stress incontinence if present and allow for future intercourse.
Who?
Surgery is performed on women experiencing pelvic organ prolapse, which
is often the result of pregnancy and/or childbirth. Any surgery for pelvic organ
prolapse is considered major surgery, and the decision should not be taken
lightly. Depending on the degree to which you are experiencing prolapse, your
health care provider may desire to start with a less-invasive treatment first,
such as pelvic floor exercises, biofeedback, and/or use of a
pessary (a
supportive device for the vagina).
The
Pros
- In severe cases of prolapse,
surgery may be the only way to find relief from pelvic discomfort and
stress incontinence.
- In almost all cases,
a skilled surgeon can usually perform reconstructive surgery that will allow
for normal sexual function following the recovery period.
The
Cons
- A few women
may need to have the surgery repeated later in life, especially women who
had their initial surgery done at a relatively young age.
- The surgery usually requires
general anesthesia and an overnight hospital stay for up to two nights.
- The recovery period after the
surgery generally requires no heavy lifting for approximately six to twelve
weeks.
- While surgery can fix pelvic
organ prolapse, it may not always fix all types of urinary incontinence.
This surgery is not intended to resolve urge urinary incontinence.
- In rare cases the surgery can
contribute to urinary retention from too tight of a sling. This can be
corrected in a minor surgical procedure with local anesthetic and a few
hours in the hospital.
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Surgery
for Stress Urinary Incontinence (SUI)
Medical Reviewer: Nejd Alskiafi,
M.D.
Surgeries for
stress incontinence involve creating a small hammock under the bladder neck or
mid urethra to help support it. Depending on the specific type of surgery, the
hammock can be constructed of tissue taken from another area of your own body,
or a synthetic material. When your sphincter muscle clamps down on the urethra,
it presses against this new "hammock" which provides resistance and
clamps the urethra closed, helping to keep urine in.
Who?
These
surgeries have typically been done on women with stress urinary incontinence,
but new evidence is also showing good success rates in men with stress
incontinence, particularly after treatment for a prostate
problem.
The Pros
- The
procedure is quite safe for most men and women, and has been successfully
performed on adult women of all ages, including women in their 90s.
- Eighty to
ninety percent of people who have a surgery for stress incontinence
experience improved continence.
The Cons
- The
recovery includes a number of weeks of no heavy lifting, intercourse, or
strenuous exercise.
- You may
still need to wear an absorbent product, even if the incontinence is
lessened.
- As
with any surgical procedure, this treatment carries risks.
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Urine
Collection Devices for Men
Medical
Reviewer: Mary
Ann Anichini, GNP-BC
Some urine collection devices, worn externally, are designed specifically for
the anatomy of men, including, for example, the condom catheter. There are
disposable and reusable products, and some are designed specifically for use
during the day while upright and walking or sitting in a wheelchair, or during
the night when lying down. There are a variety of different types of products,
but all are management tools and none actually treat incontinence.
Who?
If you are using an incontinence management device, it is always
important to speak to a medical professional about incontinence so that you can
properly rule out any serious underlying cause, and find the treatment option
that works best for you. Sometimes there may not be an appropriate treatment
option available, and therefore you might continue to use a collection device.
Often an individual may attempt a treatment option but still needs to wear some
level of protection as occasional or slight leakage still occurs (as often
happens when on medication or after a surgery for the treatment of
incontinence).
The
Pros
- The products offer the
security of knowing that should leakage occur, something is in place to
collect it.
- For many people with
incontinence, absorbent products and/or collection devices are the only
options.
The
Cons
- There is an ongoing cost
associated with using products.
- You may feel self-conscious
using the products due to possible bulkiness or noise.
- You might feel embarrassed
buying the products.
Tips
and Tricks
Skin: Keeping the skin that comes into contact with urine or BM clean
and dry is important. When changing absorbent products, wash the perineal area
with mild soap (not deodorant) and warm water, then pat the skin dry (do
not rub). Application of a skin ointment such as A&D can further protect the
skin.
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Vaginal
Weights or Cones
Medical Reviewer: Diana
Hankey-Underwood, MS, WHNP-BC
Have you seen people exercise by lifting small weights over and over?
This builds up muscles. Vaginal
cones or weights are used the same way to help women do weight-lifting exercises
for the pelvic floor.
The
vaginal weights or cones are usually ordered through a catalog or website. They usually come as a set
with several different weights. The weights are smooth and are made of plastic
on the outside with a metal weight inside. They
have a string to help you pull them back out when you are done with them. They are usually shaped like a V or cone.
In
the comfort of your own home, you put the lightest weight all the way into your
vagina. It does not have to go to
the far end, but it needs to be above the opening.
It may feel like it is trying to peek out, or it may fall all the way
out, so the first time you try this, you may want to stand over a soft towel.
After you put the cone in, try to contract or squeeze the vaginal muscles around
your finger as you remove it from the opening.
Use those muscles to hold the weighted cone in place for a short time.
Try to imagine getting the cone to move up the vagina by using your muscles,
like swallowing upside down. Some people imagine an elevator. Can you make the cone go up and down in the elevator? Can it go fast and then slow?
Each
time you exercise you can try to hold it longer. You can try to ‘move that elevator’ more times with each set.
Once you can do all this with the lowest weight cone, you should begin to
use the next weight in the set. As the pelvic floor muscles get stronger, you
should be able to stay dry longer.
Who?
Weights or cones can be used by women who have stress
urinary incontinence, or other problems
from a weak pelvic floor. The weights
and cones must
be inserted into the vagina, which some women don’t like very much, but they
can be used in private at home.
The
Pros
- The weights make sure you
exercise the right pelvic floor muscles.
- Buying something gives some
people motivation to exercise.
The
Cons
- You have to do the exercises
regularly for them to work.
- You must do the exercises as
often as needed. This might be
several times a day.
- You
must keep doing the exercises because the muscles can get weak again.
- Some women are uncomfortable
putting anything into their vagina.
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